髋椎综合征:诊断困难

A. A. Kargaltsev, M. A. Makarov, S. A. Makarov, A. Lila
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摘要

简介髋椎综合征(HSS)是髋关节骨关节炎(OA)和退行性腰椎管狭窄症(LSS)并存的综合征。治疗 HSS 患者的主要困难在于早期诊断和选择正确的手术,因为错误会导致疼痛持续存在。现有的诊断算法显示,15%-20%的患者选择正确的手术治疗失败。在我们的调查中,我们展示了髋关节综合征患者的检查结果。我们对 378 名具有典型疼痛模式(臀部、腰椎、腹股沟和髋外侧)且难以确定疼痛源的患者进行了检查。根据检查结果,我们将患者分为三组--髋关节综合征患者(100 人)、髋关节 OA 患者(172 人)和髋关节综合征患者(106 人)。我们使用哈里斯髋关节评分、Oswestry残疾指数和视觉模拟评分来确定髋关节和腰椎的功能状态和疼痛程度。HSS患者的疼痛程度(76.5±9.1 mm)高于髋关节(68.3±7.9 mm)或腰椎病变患者(67.4±7.9 mm)(P<0.05)。HSS患者的Harris髋关节评分(52.7±8.1分)与髋关节OA患者(55.5±9.1分)相同,这些患者的Oswestry残疾指数(44.2±7.6%)与LSS患者(43.2±7.8%)相同。首次就诊时疼痛程度高、Harris髋关节评分和Oswestry指数低,再加上临床检查,有助于怀疑髋关节-脊椎综合征,并建议进行髋关节和腰椎造影检查。
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Hip-spine syndrome: Diagnostic difficulties
Introduction. Hip-spine syndrome (HSS) is a combination of coexisting hip osteoarthritis (OA) and degenerative lumbar spine stenosis (LSS). Main difficulties in treating patients with HSS are in early diagnostics and in choosing right surgery, because mistakes lead to pain maintenance. Existing diagnostic algorithms show right surgery choosing failure in 15–20%. We present results of examination patients with HSS in our survey.The aim – to present clinical and instrumental results of examination of patients with hip-spine syndrome.Materials and methods. We have examined 378 patients with typical pain pattern (buttocks, low back spine, groin and lateral hip) and difficulties in pain source definition. We performed hip X-rays and low back spine MRI.Due to results we divided patients into three groups – patients with HSS (n=100), with hip OA (n=172) and patients with LSS (n=106). We used Harris Hip Score, Oswestry Disability Index and Visual Analogue Score to determine hip and lumbar spine functional status and pain level.Results. Patients with HSS had higher (p<0.05) pain levels (76.5±9.1 mm) than patients with hip (68.3±7.9 mm) or lumbar spine pathology (67.4±7.9 mm). Harris Hip Score in patients wirh HSS (52.7±8.1 points) was same as in patients with hip OA (55.5±9.1 points), Oswestry Disability Index in these patients (44.2±7.6%) was same as in patients with LSS (43.2±7.8%).Conclusion. High pain level and low Harris Hip Score and Oswestry index, along with clinical examination, on first visit can help suspect hip-spine syndrome and recommend both hip and lumbar spine imaging.
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